Kuzan-Fischer Claudia M, Parker Whitney E, Schwartz Theodore H, Hoffman Caitlin E
Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York, USA.
Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York, USA.
World Neurosurg. 2020 Jul;139:762-774. doi: 10.1016/j.wneu.2020.03.032.
Though frequently effective in the management of medically refractory seizures, epilepsy surgery presents numerous challenges. Selection of the appropriate candidate patients who are likely to benefit from surgery is critical to achieving seizure freedom and avoiding neurocognitive morbidity. Identifying the seizure focus and mapping epileptogenic networks involves an interdisciplinary team dedicated to formulating a safe and effective surgical plan. Various strategies can be employed either to eliminate the epileptic focus or to modulate network activity, including resection of the focus with open surgery or laser interstitial thermal therapy; modulation of epileptogenic firing patterns with responsive neurostimulation, deep brain stimulation, or vagus nerve stimulation; or non-invasive disconnection of epileptic circuits with focused ultrasound, which is also discussed in greater detail in the subsequent chapter in our series. We review several challenges of epilepsy surgery that must be thoughtfully addressed in order to ensure its success.
尽管癫痫手术在治疗药物难治性癫痫方面常常有效，但也面临着诸多挑战。选择可能从手术中获益的合适候选患者对于实现无癫痫发作和避免神经认知并发症至关重要。确定癫痫病灶并绘制致痫网络需要一个跨学科团队致力于制定安全有效的手术计划。可以采用各种策略来消除癫痫病灶或调节网络活动，包括通过开放手术或激光间质热疗切除病灶；通过响应性神经刺激、深部脑刺激或迷走神经刺激调节致痫放电模式；或使用聚焦超声对癫痫回路进行非侵入性切断，本系列后续章节将更详细地讨论这一点。我们回顾了癫痫手术的几个挑战，为确保其成功必须认真应对这些挑战。
